The evolving issues around PIP breast implants shows how confusing things can become in health. In a nutshell the company, which makes these implants, was closed in 2010. It was accused of using a lower grade of silicone (industrial rather than medical grade), which is more likely to rupture. As this is posted the French authorities have been questioning the company founder. Charges may follow.

The obvious first question, is how were implants with lower grade silicone able to be sold and used for a number of years before being detected? No doubt this will be the subject of an inquiry. It has been alleged that the company was in financial difficulties and saw the use of the lower grade, and hence cheaper, silicone as a way of cutting costs.

What is staggering is the different advice being given to women, based on the country they live in. In France the authorities are advising all women to have the implants removed and the French government will pay for it. The Netherlands is recommending the same but not offering to pay. In the UK the authorities are looking into it. In Australia the TGA has not advised routine removal. In the USA they were never approved for use in the first place.

Here is a statement of the obvious-you would think. Either there are grounds to advise routine removal or there is not. How can authorities in different countries come to vastly different conclusions based on the same information? The reason to recommend removal is that the implants are felt to be more likely to rupture. Yet even here there are differing rupture rates in different countries. This may be a function of surgical techniques although nobody knows. Australian rupture rates with the PIP implants are comparable to those of other implants.

The other significant matter here is why has it taken so long for this to play out? The company was closed down in March 2010 with the discovery of lower grade silicone. At this point no further implants were used.

This raises the next obvious point. If they were not deemed suitable to be inserted into women from that time why were women who already had these implants not told about this? It is over 18 months since the implants were removed from the market. Why has it taken so long for this issue to get public notice?

There is no link between the implants and breast cancer. The main problem (aside the obvious one of aesthetics) with a ruptured implant is irritation of breast tissue. It is now emerging though that there is an “association” between the ruptured implants and a rare form of lymphatic cancer. No causative factor has been found and it is important to note that association does NOT equal cause and effect.

However this muddies the waters further and will likely lead more women to seek removal.

So we have a product which has been “substandard: for some years but still used. Once found out it is no longer used but it takes over 18 months for recommendations to come out for women who already have the implant. And to cap it off what you are advised to do is a function of where you live!

Confused?? You should be.

The unspoken issue in all this is the “explosion “ of the use of implants. Originally made for women who had a mastectomy (breast removal) due to breast cancer, the vast majority are now used by women who just want bigger breasts.

There is never such a thing as a free lunch. Women (and rarely men) who choose to have this form of surgery are entitled to do so. Yet why should women feel that they need bigger breasts to feel better about themselves? What does this say about our society?

The marketing of implants as a form of “beauty treatment” is also highly questionable. We are not talking about selling lipstick here but invasive surgery done under general anaesthetic.

The PIP implant story is almost a parable of our times. The lure of a quick fix (I want to “look other than I do”) lures people to have procedures done without asking enough questions or thinking about possible consequences. When it all turns sour somehow the government is supposed to fix it.

Cosmetic procedures such as breast implants are an example of where medical procedures are catering to public desire rather than medical needs. They are a consumer product not a medical treatment (except post mastectomy).